CPAP治疗对老年阻塞性睡眠呼吸暂停患者老年抑郁量表评分的影响

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中文摘要

目的： 本研究旨在探讨CPAP治疗对OSA患者抑郁评分的影响，OSA与老年人群生活质量受损和功能衰退相关。
方法： 本研究为一项双向性队列研究，纳入年龄65-80岁、经多导睡眠图确诊为中重度OSA的老年患者。采用老年抑郁量表（GDS）评估初始抑郁症状。根据对CPAP的依从性对参与者进行分类。从设备下载获取客观CPAP使用数据，包括平均每晚使用时间和使用夜数百分比。采用多元线性回归分析抑郁的基线预测因素。采用协方差分析（ANCOVA）分析CPAP依从性对治疗后GDS评分的影响，并调整初始抑郁评分。模型还以体重指数、最低血氧饱和度和随访时长作为额外协变量运行，并计算效应量。
结果： 53例患者中，31例（58.5%）依从CPAP。依从组与非依从组的人口学和临床特征相似。回归分析显示，较低的夜间血氧饱和度（p=0.012）和较高的体重指数（BMI）（p=0.011）与较高的初始GDS评分独立相关，而呼吸暂停低通气指数与抑郁症状无显著关系。调整初始GDS评分后，依从组治疗后抑郁评分显著低于非依从组（调整后平均GDS：7.15±0.18 vs. 10.10±0.21，p<0.001）。调整后平均差为2.95分（95% CI 2.40-3.50；偏η²=0.70）。依从组平均每晚使用时间为6.44±0.97小时，非依从组为2.41±0.95小时，使用夜数百分比分别为88.4±15.0%和36.0±25.0%（p<0.001）。
结论： CPAP依从性与OSA老年人抑郁症状的显著减轻相关。夜间低氧血症和肥胖是抑郁严重程度的关键预测因素。这些发现表明，有效的OSA治疗可能改善老年人的心理健康结局。

英文摘要

PURPOSE: The aim of this study is to investigate the effect of CPAP treatment on depression scores in OSA, which is associated with impaired quality of life and functional decline in the geriatric population.
METHODS: The study was an ambispective cohort involving geriatric patients aged 65-80 with moderate-to-severe OSA confirmed by polysomnography. Initial depressive symptoms were assessed using the Geriatric Depression Scale (GDS). Participants were categorized based on their adherence to CPAP. Objective CPAP usage data, including mean nightly usage time and the percentage of nights used, were obtained from device downloads. Baseline predictors of depression were examined using multiple linear regression. The effect of CPAP adherence on post-treatment GDS scores was analyzed with analysis of covariance (ANCOVA), adjusting for initial depression scores. The model was also run with body mass index, lowest oxygen saturation and follow-up duration as additional covariates, and effect sizes were calculated.
RESULTS: Of the 53 patients, 31 (58.5%) adhered to CPAP. Demographic and clinical characteristics were similar between adherent and non-adherent groups. Regression analysis showed that lower nocturnal oxygen saturation (p = 0.012) and higher body mass index (BMI) (p = 0.011) were independently associated with higher initial GDS scores, while the apnea-hypopnea index was not significantly related to depressive symptoms. After adjusting for initial GDS scores, the adherent group had significantly lower post-treatment depression scores compared to non-adherents (adjusted mean GDS: 7.15 ± 0.18 vs. 10.10 ± 0.21, p < 0.001). The adjusted mean difference was 2.95 points (95% CI 2.40-3.50; partial η² = 0.70). Mean nightly use was 6.44 ± 0.97 h in the adherent group and 2.41 ± 0.95 h in the non-adherent group, on 88.4 ± 15.0% and 36.0 ± 25.0% of nights respectively (p < 0.001).
CONCLUSIONS: CPAP adherence was associated with a significant reduction in depressive symptoms in older adults with OSA. Nocturnal hypoxemia and obesity were key predictors of depression severity. These findings suggest that effective OSA treatment may improve mental health outcomes in the elderly.